Bontrager 4 & 5 Test
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| A. CR perpendicular to IR, directed to third MCp jointB. separates the radius and ulnaC. Pronate hand with palmar surface in contact with IR; spread fingers slightly.
•Align long axis of hand and forearm with long axis of IR.
•Center hand and wrist to IR.D. Seat patient at end of table with elbow flexed about 90° and hand and wrist resting on IR, palm down. Drop shoulder so that shoulder, elbow, and wrist are on same horizontal planeE. Minimum SID—72 inches (183 cm) •
IR size—35 × 43 cm (14 × 17 inches), crosswise, or (10 × 12 inches) crosswise for unilateral exposures
Digital systems—70 to 80 kV rangeF. Seat patient at end of table, with elbow flexed
90°G. A less frequent PA wrist projection involves the radial deviation movement that opens and best demonstrates the carpals on the opposite, or ulnar, side of the wrist—the hamate, pisiform, triquetrum, and lunate.H. Seat patient at end of table, with elbow fully extended, if possible.I. Increase 3 kV to 4 kVJ. Seat patient at end of table, with elbow flexed 90°K. Distal radius and ulna, carpals, and at least the midmetacarpal area are visible.L. Position patient to direct CR to midway between AC joints. • Center midline of IR to CR (top of IR should be approximately
2 inches [5 cm] above shoulders).M. Angle CR 10° to 15° proximally, along long axis of forearm and toward elbow. (CR angle should be perpendicular to long axis of scaphoid.)
• Center CR to scaphoid. (Locate scaphoid at a point 2 cm [34 inch] distal and medial to radial styloid process.)N. Anatomy Demonstrated: • Both AC joints, entire clavicles, and SC joints are demonstrated.O. Distal radius, ulna, carpals, and at least to midmetacarpal area are visible. • Trapezium and scaphoid should be well visualized, with only slight superimposition of other carpals on their medial aspects.P. Minimum SID—40 inches (102 cm) •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
65 TO 70 kV rangeQ. Adjust hand and wrist into a true lateral position, with fingers comfortably flexed; if support is needed to prevent motion, use a radiolucent support block and sandbag, and place block against extended hand and fingersR. CR perpendicular to IR, directed to scapulohumeral joint (2 or 2-1/2 inches [5 or 6 cm] below top of shoulder)S. Oblique projection of the entire hand and wrist and about 2.4 cm (1 inch) of distal forearm are visible.T. Seat patient at end of table, with hand and arm
fully extended and palm up (supinated). |
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